Oaks Of West Kettering The

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

were to perform a full body skin assessment as part of their systemic approach to pressure injury prevention and management. The policy stated the documentation of the skin assessment was to include documentation of wound observation, wound location, and other information as indicated or appropriate.

Review of the facility policy titled, Wound Management and Documentation, revised [DATE REDACTED] stated the following elements are documented as part of a complete wound assessment included type of wound, stage of wound or degree of skin loss if non-pressure, measurements, and description of wound bed.

This deficiency represents non-compliance investigated under Complaint Number 1353685 (OH00164606).

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oaks of West Kettering The

1150 West Dorothy Lane Kettering, OH 45409

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff and resident interviews, and policy review, the facility failed to complete indwelling catheter care as per policy. This affected one (#62) rout of three residents reviewed for indwelling catheter care. The facility census was 95. Findings include: Review of the medical record for Resident #62 revealed an admission date of 06/21/24 with medical diagnoses of chronic respiratory failure with hypoxia, chronic viral Hepatitis C, neuromuscular dysfunction of bladder, anemia, paraplegia. Further review revealed Resident #62 discharge to hospital on [DATE REDACTED] and readmission to the facility on 06/13 /25. Review of the quarterly Minimum Data Set (MDS) assessment, dated 05/14/25, indicated Resident #62 was cognitively intact, was dependent upon staff for all activities of daily living and had an indwelling catheter.

Review of the medical record revealed a care plan, dated 11/20/24, which stated Resident #62 had an urinary catheter related to neurogenic bladder with an intervention to perform catheter care every shift.

Review of Resident #62's June 2025 Treatment Administration Record (TAR) revealed there was documentation to support staff completed indwelling catheter care every shift from 06/01/25 until 06/06/25.

However, further review of June 2025 TAR revealed no documentation to support the facility staff completed indwelling catheter care for Resident #62 after readmission on [DATE REDACTED] until 07/01/25. Interview on 08/19/25 at 11:31 A.M. with Resident #62 stated staff usually do not perform catheter care on her for the night shift.

Resident #62 stated she has gone several days without catheter care getting done. Interview on 08/19/25 at 2:30 P.M. with [NAME] President of Clinical Services (VPCS) #210 stated the expectation was for staff to complete indwelling catheter care for any resident with an indwelling catheter every shift. VPCS #210 confirmed the medical record for Resident #62 did not have documentation to support the facility completed indwelling catheter care as per facility standards and policy following the residents readmission in June

1. 2025. Review of the facility policy titled, Catheter Care, revised 03/01/25, stated the facility to ensure that

residents with indwelling catheters receive appropriate catheter care and maintain their dignity and privacy when indwelling catheters are in use. The policy stated catheter care would be performed every shift and as needed by nursing personnel. This deficiency represents non-compliance investigated under Complaint Number 1353687 (OH00165443).

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oaks of West Kettering The

1150 West Dorothy Lane Kettering, OH 45409

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

facility. VPCS #210 confirmed the dialysis center in the facility was not affiliated with the facility's parent company. VPCS #210 confirmed that the medical records for Resident #07 and #08 did not contain documentation to support the facility staff completed thorough pre-dialysis assessments and the medical records did not contain documentation to support the facility completed post dialysis assessments for the residents once they returned from dialysis. VPCS #210 also confirmed that the medical record for Resident #100 did not contain documentation to support the facility completed pre or post dialysis assessments.

Review of the facility policy titled, Hemodialysis, revised 03/01/25 stated the facility would provide the necessary care and treatment, consistent with professional standards of practice, physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences, to meet the special medical, nursing, mental, and psychosocial needs of residents receiving hemodialysis. The policy stated

the facility would ensure that ongoing assessment of the resident's condition and monitoring for complications before and after dialysis treatments received at a certified dialysis facility. This deficiency represents non-compliance investigated under Complaint Number 1353687 (OH00165443).

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oaks of West Kettering The

1150 West Dorothy Lane Kettering, OH 45409

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

will perform proper hand hygiene procedures to prevent the spread of infections to other personnel, residents, and visitors. The policy stated “hand hygiene” is a general term for cleaning your hands by handwashing with soap and water or the use of an antiseptic hand rub, also known as alcohol-based hand rub (ABHR). The policy stated the sue of gloves does not replace hand hygiene, and if your task required gloves to perform hand hygiene prior to donning gloves and immediately after removing gloves. 2.Review of the medical records for Resident #08 revealed an admission date of 07/19/25. Diagnoses included fracture of left fibula, sepsis, cellulitis, end stage renal disease, type two diabetes, neuromuscular dysfunction of the bladder, anemia, abscess of foot, dependence on renal dialysis, and hypertension.

Review of MDS dated [DATE REDACTED] revealed Resident #08 admitted with a stage three pressure ulcer and was independent with self-care.

Review of the care plan dated 8/5/25 revealed Resident #08 was, at risk for impaired skin integrity with interventions to monitor skin for moisture, apply barrier product as needed, monitor skin for redness, specifically over bony prominences, provide skin care per facility guidelines and PRN as needed. The care plan also stated, the resident has pressure ulcer to right buttock for pressure ulcer development with interventions to administer treatments as ordered and monitor for effectiveness, weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue, and exudate. The care plan also stated, the resident has a [NAME]/stasis ulcer with interventions to evaluate wound for size, depth, margins: peri-wound skin, sinuses, undermining, exudates, edema, granulation, infection, necrosis, eschar, gangrene and document progress in wound healing on ongoing basis.

Review of Resident #08 order dated 07/29/25 revealed, enhanced barrier precautions due to dialysis and wounds. Further review of orders dated 8/13/25 revealed wound care to the right buttocks, cleanse, pat dry, apply alginate and bordered foam dressing every Tuesday, Thursday, and Saturday and as needed.

Observation on 08/19/25 at 10:03 A.M. of wound care for Resident # 08 revealed Licensed Practical Nurse (LPN) #232 explained the wound care procedure to Resident #08 then performed hand hygiene and applied gloves. LPN #232 removed the old dressing, performed hand hygiene, reapplied gloves, and completed wound care as ordered. The observation revealed LPN #232 did not don a gown during wound care. Observation also revealed a enhanced barrier precaution sign and personal protective equipment (PPE) cart located outside of the Resident #08's room.

Interview on 08/19/25 at 10:11 A.M. with LPN #232 confirmed the resident was to be in enhanced barrier precautions, an enhanced barrier precaution sign was posted on the resident's door, and PPE was outside of the resident's room. LPN #232 confirmed they did not wear PPE during wound care for Resident #08.

Review of the facility policy, Enhanced Barrier Precautions last revised on 7/1/25 revealed enhanced barrier precautions will be ordered for residents with wounds and personal protective equipment is necessary when performing high-contact care activities including wound care.

This deficiency is based on an incidental finding discovered during the course of the complaint investigation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oaks of West Kettering The

1150 West Dorothy Lane Kettering, OH 45409

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Level of Harm - Minimal harm or potential for actual harm

Based on medical record review, observations, and staff and resident interviews, the facility failed to ensure resident room was free from flies. This affected one (#11) out of three residents reviewed for pests/insects

in rooms. The facility census was 95. Findings include: Review of the medical record for Resident #11 revealed an admission date of 07/26/25 with medical diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and hypertension. Review of the admission Minimum Data Set (MDS) assessment, dated 08/02/25, revealed Resident #11 had moderate cognitive impairment and required partial/moderate staff assistance with toilet hygiene and substantial/maximum assistance for bathing, transfers, and bed mobility. Observation with interview on 08/18/25 at 11:28 A.M. of Resident #11's room revealed six flies either flying in the room or sitting on Resident #11's bedsheets. Resident #11 stated he has had issues with flies in his room since he arrived at the facility. Interview on 08/18/25 at 11:33 A.M. with Licensed Practical Nurse (LPN) #256 confirmed Resident #11's room had six flies either flying around in his room or sitting on his bed. Observation on 08/19/25 at 8:05 A.M. of Resident #11's room revealed the resident was sleeping and three flies noted to be sitting on his bed. Interview on 08/19/25 at 8:08 A.M. with LPN #232 stated several resident rooms have issues with flies and gnats which have been going on for a while. Interview on 08/19/25 at 8:47 A.M. with Maintenance Director #304 stated he started at the facility about one month ago and he noticed issues with flies and gnats in resident rooms. Maintenance Director #304 stated he had been working to resolve the fly and gnat issues with treatments to sinks and drains and had seen some improvement. Maintenance Director #304 stated a pest control company provided treatments monthly to common areas and kitchen and will spot treat rooms as needed. This deficiency represents non-compliance investigated under Complaint Number 1353684 (OH00166903).

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet